THE FUTUREof Small Medical Practices

THE FUTUREof Small Medical Practices

INTRODUCTION

table of contents

Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2

Regulation Changes of the Trump Administration . . . . . . . . . . . . 2

The Independent Physician Dilemma . . . . . . . . . . . . . . . . . . . . . . 3

What Patients Want and How to Accommodate Them . . . . . . . . . 4

Some In-Office Considerations . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5

Staying Up to Date on Technology . . . . . . . . . . . . . . . . . . . . . . . . . 6

Predictions for the Future . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7

Conclusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7

About Henry Schein MicroMD . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8

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INTRODUCTION

REGULATION CHANGES OF THE TRUMP ADMINISTRATION

The healthcare industry seems to change in the blink of an eye. From regulations to payment changes, the evolution of

patient wants and technological advances, this isn’t your mother’s medical field anymore. This near-constant state of transition can be particularly difficult for small, independent practices to keep up with. For this reason, it’s important for independent primary care physicians to stay on top of these changes. Remaining constantly aware of the shifts taking place in the industry allows physicians to maintain independent status.

In this eBook, we’ll take a closer look at the future of the small medical practice and options for clinicians who want to remain

autonomous. Many feel that it’s becoming too difficult in today’s healthcare climate to stay entirely independent, and we have some insight. We’ll start by looking at regulation changes under the administration of President Donald J. Trump. After, we will move into an exploration of the independent physician dilemma & deciding to stay solo or do something else. We’ll then discuss what patients want and how doctors can accommodate those desires and some in-office considerations for doctors striving to maintain their own small practice. Lastly, we will discuss important technology to stay up to date on, and finish up by looking at some predictions for the future of primary practice. It’s a lot of ground to cover, but will give physicians the information they need as they decide whether to keep that independent dream alive or modify it slightly.

During the 2016 presidential campaign, then-candidate Trump made it clear that his intention, should he be elected, would be

to “repeal and replace” the Patient Protection and Affordable Care Act (ACA). This act is otherwise referred to as Obamacare. He also expressed interest in reforms that could affect Medicaid funding, regulation of the pharmaceutical industry, and the health insurance industry in general. Changes have been implemented regarding these facets of healthcare since he has taken office.

One of the first major steps President Trump took in his plan to repeal the ACA was to sign an executive order on October 12,

2017 that would modify the ACA in five ways. These changes took effect in January of 2018 and are as follows:

• Expanded access to association health plans available to trade groups and small business, among other associations. This change also expanded the types of groups that could form these sort of associations and stops them from refusing coverage or charging a higher premium for those with pre-existing conditions. This also allows health insurance companies to sell policies across state lines, however each state has its own specific regulations regarding such sales.

• Eased restrictions on short-term health plans, allowing them to last up to 12 months versus the three months they were permitted under the ACA.

• Allowed employers to use pretax dollars for health reimbursement arrangements meant to help workers pay for any medical expenses. Under the ACA these dollars were restricted to only be used for policies that met ACA rules.

• Commissioned a study to find ways to limit insurance and hospital consolidation.

• Directed federal agencies to find additional means to increase choice and competition in regards to

health care.

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Just over two months after signing this executive order into legislation, on December 22, 2017, President Trump signed the Tax Cuts and Jobs Act which, among other

things, repealed the ACA tax on individuals who earned income of a certain level and elected not to purchase health insurance. Finally, as of January 11, 2018 President Trump’s administration has declared that individual states may impose work requirements on recipients of Medicaid. This change is most likely to affect single adults without children who were receiving their Medicaid benefits as a result of the ACA expansion. Those benefit costs may change due to the pool of individuals now receiving coverage. These changes will affect your patients and that will ultimately trickle down to you whether in the form of receiving lower reimbursements due to fewer of your patients having insurance coverage or in providing benefits for your staff. Those benefit costs may change due to the pool of individuals now receiving coverage.

The other, more obvious, regulations that affect your practice are under MACRA, namely the Quality Payment Program. This program remains largely

unchanged with most of the same points emphasized for Year Two under the Trump Administration as were emphasized in Year One under the Obama Administration. The main changes made to the QPP will serve to benefit your small practice as many options and incentives were added to ease small practice participation for 2018.

THE

AMERICANHEALTH CAREACT

THE INDEPENDENT PHYSICIAN DILEMMA Staying Independent Isn’t Easy

Managing an independent physician practice is a truly business endeavor with the core service being what doctors went

to medical school for – healing people. Running a business isn’t easy. The emergence of multiple regulatory, payment program, and technologies will require that practices be successful at implementing changes that seems more geared towards commercial businesses rather than a physician practice. Not everyone has the desire, time, or expertise to do it successfully. Some physicians find options more attractive – sell their practice to a larger health network, merge with a large practice “mega-group”, or simply go directly to work for a hospital or another practice. Part of that decision is to consider the alternatives. There are some in-between options to retain independence that can help the practice run a better business and allow providers to get back to business of healing. Ensure you have the right motivation, people, and supporting technology. First, you need to know what you want – or don’t want. Do you want to control your schedule and patient load? Do you want to control your processes? Do you want to grow your income? Or do you value other things that make hospital employment more attractive?

I f your choice leans more towards staying independent, consider hiring an office manager with true business experience. Often

practices seek to simply hire someone with pure health practice experience. The reality is that someone can have an Office Manager title although their responsibilities may have been limited to simple scheduling and billing. It’s important to determine the goals of the practice and make the case for hiring someone who can – and will be empowered – to achieve those goals. You can train someone in how a practice works, though it may be harder to train an office manager in traditional business practices. As you consider future hiring options, it’s important to understand what responsibilities and successes candidates have had with navigating changes that impact the practice (business), engaging staff to identity needed improvements, capturing, benchmarking, and monitoring key practice metrics, leading teams through project plans, managing and engaging people, and being successful in important initiatives that can impact patient growth, retention, and safety, population health management, streamline front desk, clinical, and billing practices. Finally, consider how technology can help. Yes, there is a cost to technology, although the investment and successful usage of many technologies can save time, free staff up to focus on other critical initiatives, and earn the business more profitable revenue. If you opt to merge with a mega-group or sell to a hospital, ask to retain your existing technologies that are having a positive impact. Often you can negotiate that as part of your agreement.

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WHAT PATIENTS WANT AND HOW TO ACCOMMODATE THEM

Patients are the lifeblood of your practice. They are your work and your income. It would do you well to determine what your patients desire in a practice and at least strive to make some of that a reality. It

seems today’s patients are no longer simply looking for the doctor who can provide the best treatment. They’re looking for the doctor who can provide the best treatment, with a nice office staff, where operations

are convenient for them, and they feel heard. Yes, the times they are a’changin’. Let’s look at some of the specifics that today’s patients are seeking in their ideal primary care practice:

Extended hours - Your patients are busy, just like you. They have jobs, kids, homes, businesses, hobbies and a million things to do every day. Getting to a doctor’s office to be seen between the hours of 8:00 am and 5:00 pm, Monday through Friday just isn’t always possible. This is why when your patients are sick they’re visiting urgent cares, emergency rooms, and walk-in clinics. They perceive their primary care practice as a place that they need to make an appointment in advance, take time off work, and rearrange the rest of their busy schedule. So change their mind. Add a later evening or two to your schedule. Extend your Saturday hours. Maybe have some hours where patients who are sick can just walk in without even having to make an appointment. Think outside the traditional Monday through Friday box and make seeing you a more convenient choice for them.

Convenience in the form of a one-stop shop - Again, your patients are busy. They don’t have time to come to you for an appointment, drive across town for a lab, wait a few days to get an x-ray, etc. The more services you can have available in or close to your building for them, the better.

Welcoming complaints and opinions - Everyone has opinions, and we know some of them are not pleasant, but everyone likes to be heard. Your patients want to feel like they can share their concerns with you. It makes them feel like they matter.

It also helps you out, as what your patients are saying can give you greater insight into how you

can improve your practice. Making it clear that you’re open to what they have to say is a good business move and your patients will really appreciate it.

Two-way communication - The key to any relationship is good communication; the

patient/physician relationship is no different. Your patients need to be able to reach you and they need to hear from you about important details when it comes to their health. Make

this convenient. This is where a patient portal comes in very handy. If you don’t have

a patient portal available or if a large number of your patients haven’t signed up for your portal, fix

this. If you do have a portal, make sure you’re using it to its greatest capacity. Patients appreciate the ability to directly message their doctor when they have a non-urgent question, not to mention transferring patient data between providers is much easier with a portal. This is one that won’t just make your patients happier, it’ll make your life easier, too.

The bottom line of what patients want is evolving from what traditional physician

practices have delivered in the past. Patients want affordable

options and price transparency. They want face time with their physicians. They want convenient, on-demand appointments that

fit their schedule. They want to know their providers are staying on top of technology. They want open communication through

multiple ways to communicate outside of the patient visit. They want access to their health records. They want a trusted doctor

who cares and is fully engaged in managing their care. Much of that involves implementing and optimizing technology to gather

patient feedback, provide cost estimates prior to visits, offer secure communication channels, minimize wait time, reduce data

entry during visits, or providing mobile population management tools to assist patients in sticking to their care plans. A good non-

tech change may be to simply expand or shift hours of availability to mesh with busy patient schedules.

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SOME IN-OFFICE CONSIDERATIONSSo let’s say you’ve decided to remain independent in a small practice. You understand all the regulations, and how they’ll affect you. You’ve also taken a look at what your patients want and you’re working on fulfilling those desires. What now? Now you need to make sure your office itself is operating optimally. First you’ll want to look at your finances.

A big issue with a small medical practice is that of overhead. It’s important to

be sure that you’ve staffed your practice efficiently. You want to keep expenses down, but don’t downsize yourself all the way to chaos. Medical Assistants, for example, is one area in which you want to have a strong staff as these workers can provide a 3:1 return on their cost in helping with physicians’ productivity. Make sure that you’ve hired the right people and minimize turnover, as the hiring and training processes are expensive. Get a good staff in place and then keep them loyal. Another issue with regard to overhead is overspending on supplies. If you don’t need it, don’t buy it; and if you need to buy it, make sure you’re getting the best price on it.

Once you’ve got a handle on your overhead, it’s important to take a look

at your collections. Keeping your finger on the pulse of your practice’s accounts receivable is imperative to maintaining a successful small practice. Almost all of your claims should be paid within 30 days, if this isn’t happening do some research to figure out why and make corrections where needed. Utilize technology to make your billing more efficient. Tools like code scrubbing will check your claims before they result in delays. Using a robust clearinghouse can result in more automation when it comes to filing claims, dealing with denials, and posting payments. These tasks don’t have to be completed manually and allowing technology to help will make your business much more profitable.

F inally, take a look at your marketing. This is an area that many private practices

overlook. A lot of medical clinics are still just putting an ad in the phonebook, but when was the last time you picked up a phone book? That’s right, you probably can’t remember. Don’t waste money on advertising that doesn’t work. Today, most people can be reached online. Get a social media presence going and connect with your patients and people they know who can become your patients. It’s free in most cases and when there is a cost it’s relatively cheap. The people are already there; harness the power of social media and let it work for you.

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STAYING UP TO DATE ON TECHNOLOGY

We can’t escape technology and it’s foolish to try, but by carefully selecting the right technology for your practice you can improve clinical efficiency. Not only that, you can increase profitability, improve the

patient/physician relationship, and analyze your data to make sure your practice is performing well. Let’s look at each of these areas in more detail along with some technological tools to get you there:

Improving clinical efficiency - Use mobile devices such as tablets to improve your workflow by having patients fill out their intake forms while they wait. The information will be directly transferred to your practice PM or EMR,

eliminating the need for data entry by your staff later. Even better, utilize a patient portal like Henry Schein Secure Chart and send out intake forms ahead of time so that the information is filled in before the patient even arrives for his/her appointment.

Increasing profitability - If your practice conducts its billing in-house, a little automation can go a long way to increase your payments and lower your overhead in manual task completion. MicroMD eStatements offers MicroMD Practice Management-integrated print and electronic patient statement processing and delivery services. This enables you staff to do less manual work because the service prints each invoice individually, stuffs envelopes, and mails them. MicroMD ePayments is an integrated payment processing solution that makes it more convenient, secure and affordable to accept credit and debit card payments. We know this

is necessary as many patients, particularly the younger demographic, are operating almost entirely on credit and debit. TSI Collections is a MicroMD-integrated collection service that brings healthcare organizations better tools to manage their accounts receivable. TSI Collections helps increase cash flow by taking the legwork of collections out of your hands.

Bettering the patient/physician relationship - As a provider, it’s important to use technology in such a way that it helps you to connect with your patients and provide them with a more personal experience. Use of tools like Simplifeye

Apple Watch and iPhone powered by MicroMD EMR helps providers to deliver a more personal experience by providing quick view appointment details and patient information. Simplifeye also notifies you when patients are ready so that you can focus on providing the best possible experience for the patient you are currently with. This is also another area where a patient portal like Henry Schein Secure Chart is useful as this increases the ability for patient/physician communication and collaboration on healthcare. One of the best ways to improve your patient/provider relationship is by making sure you see your patients. Using a service like AutoRemind makes appointment reminders more efficient and appointment confirmations more accurate. Your patients are contacted according to their preferences and are able to easily respond.

Data benchmarking - Finally, use technology to understand how your practice is performing. A great tool for this is DashboardMD. This healthcare analytics platform integrates with MicroMD Practice Management and it’s already a robust reporting program to extract key financial and claims data. DashboardMD does your number crunching for you, and presents you with a clear picture of how your practice is performing.

Implementing even a couple of these tools, along with a

strong Practice Management and EHR, like MicroMD, can

help keep your practice independent.

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PREDICTIONS FOR THE FUTUREIt’s obvious that a lot has changed in the healthcare field over the past several years and decades. It’s safe to say that we’ve learned by now that the changes are likely to keep coming. So what might the future of primary care look like? Here are just a few insights:

Conclusion

I t’s clear that healthcare has changed a lot and the changes are going to keep coming. The future of small practices definitely

looks different from the past, but different doesn’t mean bad. Is it more challenging to maintain independence in today’s healthcare landscape? Yes, it certainly can be. However, with determination and the right technological tools, it’s absolutely possible to keep that autonomy and serve your patients the way they want to be served. If you’ve decided the independent route isn’t for you but you don’t want to go all the way to hospital employment, there are options in the form of mega-groups that provide the best of both worlds.

A re you interested in finding out more about MicroMD and how we can help to streamline your practice and allow you to focus on

the business of healing?

Visit micromd.com or call 1-800-624-8832 for more information today.

Waiting Room Changes - One of the biggest complaints patients have is the amount of time spent in waiting rooms because it feels like wasted minutes and sometimes hours. As healthcare continues to advance, this is likely to change. First, waiting room time is likely to be used more efficiently to collect necessary information and also possibly to conduct screenings. Over time, waiting room time is expected to be significantly reduced as physicians become more efficient and utilize more technology. Perhaps in an ideal, somewhat distant, future patients won’t have to sit in waiting rooms at all. Maybe, they will have the ability to check-in with their doctor’s office from an app and be escorted right back to an exam room when they arrive.

Virtual appointments - Something that we’ve already seen being put to use is telemedicine and this is likely to expand over the next few years. Routine appointments, follow ups, and minor ailments don’t necessarily require a trip to the doctor’s office. Therefore, telemedicine will likely play a larger role in healthcare to eliminate these unnecessary doctor’s visits.

Increasing patient control over their medical charts - Nobody knows your patients’ stories better than they do. While they may tell you all of their medical stories, time may prohibit you from manually entering the information in your EHR. In the future, it’s likely that patients will directly collaborate on their medical charts, possibly through filling out questionnaires prior to appointments that will then feed that data into their chart. This allows for greater detail to be captured and giving physicians the opportunity to focus on follow up questions during encounters to gain a deeper understanding.

Wearable technology providing real-time insights - Whether it’s a FitBit, an Apple Watch, or some other gadget, many patients are currently using some sort of wearable technology. Doctors can use these devices to get to know their patients and their health picture better. Patients can sometimes skirt the truth a little, but actual data doesn’t lie. Using the information in wearable technology could give providers the most accurate picture of their patients’ health, allowing them to provide the absolute best care. This will be particularly useful in regard to patients with chronic health conditions that are less than compliant. Wearable technology would allow providers to keep up with them and encourage them to take care of themselves.

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About Henry Schein MicroMDHenry Schein MicroMD, a subsidiary of Henry Schein, Inc., provides simple yet powerful EMR and Practice Management solutions that facilitate the delivery of superior patient care, automate incentive and quality reporting activities, and streamline operations for today’s busy providers. Full-featured, time-tested, and budget-friendly, MicroMD EMR is 2015 Edition CEHRT certified software that helps small practices, large medical groups, community health centers, and billing services accelerate progress toward a paperless environment and health information exchange with minimal disruption and stress.

Learn more at www.micromd.com.